Realistic expectations from HT

[baldeagle24]

Hello.

This is my first time on this forum and I hope to learn a lot from all you guys here!

I am a 31 year old guy and have been suffering from hair loss for the best part of 8-9 years now. I believe it is genetic since my father is near bald now, my grandfather has always been bald and my brother is balding along the crown.

So I have baldness in my family, though the baldness patterns are different. I am losing hair pretty much from the crown of my head and the temples.

I need not mention how traumatic the last few years have been for me. I leave that discussion for a drunk day! Today, I would love to hear your opinions on hair transplant and what to realistically expect from it.

I consulted with a renowned hair transplant surgeon and I was told that I make an excellent candidate for HT because I have really good donor hair. He recommended 1650 grafts (with 500 double follicular units) for the first op and the same count for the 2nd op a year later.

Its a lot of money and although I don't mind spending that (since we are talking about me getting my life back), but I want to understand the risks I am taking and more importantly, keep my expectations realistic. I had the following key questions:

1. What are the chances of failure with such an operation? In other words, is there a possibility that the transplanted hair in my case will not grow at all and the entire transplant would be a failure?

2. I have attached pictures of my scalp showing the current level of baldness. I was wondering what kind of coverage 1650 grafts (~5000 hairs) would give me? Would it cover all my bald spots? Would it partially restore a natural hairline?

3. How long do the scars show for and would it show in my case where I think I may have sufficient hair to cover the scars? This is so I understand how long I would need to be off for (from work).

I have asked all these questions to my doctor as well, but I really value opinions of people who have undergone a transplantation. This is my first ever operation, so real experiences would be invaluable for me.

Many thanks for your time, patience and help.

Regards.

[AGL]

Although you have lost a significant amount of hair, you are young and don't know what your future holds. Before you go the transplant route, have you tried medication; fin, minoxidil? I would suggest these as a first approach before looking to go down the HT path, it's not an easy journey.

[gillenator]

be24,

First and foremost, keep researching before making the final decision as we all need to understand both the benefits as well as the risks regarding hair restoration surgery. A couple of things:

1) It is extremely rare that a HT procedure fails, But we best define failure because there are many different definitions of a failed procedure. I assume that you are principally referring to a lack of regrowth. As long as you choose a reputable competent HT surgeon and that surgeon also has a competent tech staff, then the regrowth should happen. You can choose one of the most talented surgeons available but if the supporting staff is not experienced at microscopically dissecting your donor strip, causing considerable transection, then the surgeon's skills will not be of much benefit. Even if the regrowth is good, if the angulations and density are off, the end result will not look natural. To me, that is still a form of failure.

2) Based on your photos, I don not believe 1650 grafts will cover all of the balding areas especially if you are including your crown loss. I do believe that range would improve your frontal zone however. Not sure if you are taking low dose finasteride because potentially, it can greatly help that crown area from progressing further in loss. You might even experience some thickening in that region. Doubtful that it would have much of an improvement to the frontal zone. That area will take grafts to restore. IMHO, approximately 2000 - 2500 grafts would produce a nice result from the hairline transcending to the midscalp. Also consider using minoxidil to your crown as you may rejuvenate some dormant growth in the crown as well.

3) Scars are tricky. If you are normally a good healer you should be fine as long as your surgeon is competent and does not take the strip too wide for the amount of scalp laxity that you have. Obviously I am referring to a strip excision. In addition, with strip, you will need to wear your hair in the donor zone long enough to adequately cover the strip scar. The average would be approximately one inch in length to hide the linear scar.

I had four separate strip procedures for a grand total of 6,900 grafts.

Research, research!

[baldeagle24]

Gilleanator,

Thanks a ton for your detailed response.

1) The HT surgeon I am consulting comes with a very good reputation and is very experienced. Moreover, he was honest in his assessment, and never once forced me to get a procedure done immediately.

2) He did tell me that he recommends a second procedure with the same # of grafts a year later, but I will talk to him about the possibility of concentrating more grafts along the front.

Regarding propecia: I am extremely hesitant to take any drugs given their potential side-effects and I would need to think real hard before I go down that route.

3) I was actually referring to the scars in the transplanted area. I would need to go back to work the Monday after my procedure (with only the weekend in between) and was wondering if those scars would be visible given how I wear my hear. I can always use a hairloss concealer (I use Dermmatch occasionally), but not sure that is OK so soon after the HT.

Thanks again!

[35YrsAfter]

1. What are the chances of failure with such an operation? In other words, is there a possibility that the transplanted hair in my case will not grow at all and the entire transplant would be a failure?

2. I have attached pictures of my scalp showing the current level of baldness. I was wondering what kind of coverage 1650 grafts (~5000 hairs) would give me? Would it cover all my bald spots? Would it partially restore a natural hairline?

3. How long do the scars show for and would it show in my case where I think I may have sufficient hair to cover the scars? This is so I understand how long I would need to be off for (from work).

Poor growth is relatively rare. The more common problem we see with some clinics is good growth that does not have a natural appearance. Make sure you go with a doctor who knows how to create a natural looking result. Don't let a beginner touch your head. There is much more to hair restoration than what appears on the surface.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
forhair.com
Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
I am not a doctor and the content of my posts are my opinions, not medical advice.
Please feel free to call or email me with any questions. Ask for Chuck

[baldymcgee]

> Poor growth is relatively rare.

Just as well have different expectations, we all different definitions of "poor growth" and "rare"

Just keep in mind that one might define poor growth as <60% of transplanted hair growing, and may also define "rare" as <10% chances. I wouldn't want to gamble on a strip scar with 1-in-10 chances of failure.

(I'm not saying that there is 10% chance of failure, just that clinics never seem to define the words they use: "rare", "poor growth", "relatively").

Every single clinic I've asked about failure rates has been evasive (and I've spoken with reps from quite a few of the "top" ones). This is the single biggest reason that I haven't "pulled the trigger" on a transplant yet.

I'd love to see published data on the yields of different HT procedures (strip, vs manual FUE, vs ARTAS FUE).

[Jotronic]

1. What are the chances of failure with such an operation? In other words, is there a possibility that the transplanted hair in my case will not grow at all and the entire transplant would be a failure?

No grow at all? I'd say no. Someone would have to really screw up for the hair to not grow at all.

2. I have attached pictures of my scalp showing the current level of baldness. I was wondering what kind of coverage 1650 grafts (~5000 hairs) would give me? Would it cover all my bald spots? Would it partially restore a natural hairline?

It's enough for the hairline alone but even this depends on where the hairline is placed. The lower it is placed, the more hair you need. If you want the front and the back done, you're looking at closer to 4000 grafts.

3. How long do the scars show for and would it show in my case where I think I may have sufficient hair to cover the scars? This is so I understand how long I would need to be off for (from work).

This not only depends on the surgical skill and your healing characteristics but also your donor density. The stronger or higher your donor density the easier it is to hide your scar. I don't think you need an average of 1 inch to hide a typical donor scar. That's a #8 guard on the clippers which is crazy long. If done properly, a #4 guard (1\2 inch) is very possible and in some cases even shorter. I can sport a #3 guard and I've had six strips, one consolidated two wide scars into one, and I've got 9360 from my last four strips and 300 (growing) mini grafts from my first two strips.

[gillenator]

Gilleanator,

Thanks a ton for your detailed response.

1) The HT surgeon I am consulting comes with a very good reputation and is very experienced. Moreover, he was honest in his assessment, and never once forced me to get a procedure done immediately.

2) He did tell me that he recommends a second procedure with the same # of grafts a year later, but I will talk to him about the possibility of concentrating more grafts along the front.

Regarding propecia: I am extremely hesitant to take any drugs given their potential side-effects and I would need to think real hard before I go down that route.

3) I was actually referring to the scars in the transplanted area. I would need to go back to work the Monday after my procedure (with only the weekend in between) and was wondering if those scars would be visible given how I wear my hear. I can always use a hairloss concealer (I use Dermmatch occasionally), but not sure that is OK so soon after the HT.

Thanks again!

Baldeagle,

You are very welcome my friend. I think we all are hesitant in taking any meds for our hair loss yet low dose finasteride is still the most effective hair loss drug on the market IMHO. Not everyone gets the dreaded side-effects and the only way to know for sure is to try. You can always cease taking it or have the dosage adjusted but still, it is a personal decision. If you do decide to try it, do so only under the direction and supervision of a licensed physician who is experienced in treating MPB. I still see guys purchase it online without ever consulting a physician.

Thank you for clarifying your recipient area scarring question. If the surgeon is competent, and you are a normal healer, then you should be just fine without visible scarring where the recipient sites were made. The instrumentation that is used by most HT surgeons are far less invasive than they were say five to seven years ago. Many are using custom-sized blades and the incision sites subsequently close up and heal very readily.

Very doubtful that you would need any cosmetic make-up after surgery because for most, the recipient area appears normal after 7-10 days post-op. Remember, there will be the crusting that lasts that long so anything that you can apply that will advance the rate of healing can be beneficial. And if you can style your hair a little differently or pull it in a different direction, you may be able to hide any signs of surgery.

Depending how much existing native hair that you have, some of that can be lost to temporary shock loss. But if you stick to the numbers that I previously quoted, the level of trauma should not be that great. Yet we all respond differently. Just because John Doe had so and so done and experienced this and that does not imply you will respond in the same way. The same is true for the meds we talked about.

Remember to ask about who cuts your grafts and their corresponding level of experience. Why? Because the chances of transection go way down if the tech is experienced and competent. But ask in a very transparent and sincere manner. Many docs will take you on a tour of the OR area where you can meet the staff and you might even get a bird's eye view of a live procedure.

Lastly, hiding the strip scar can be more subjective than it is defined. I have seen guys cut the length as long as 3/4 of an inch and the scar still shows. And some have cropped it as short as 1/4 inch and you cannot see it. It does somewhat depend on the density after the area is closed up and healed. So the more dense the zone is generally speaking, the shorter the length required. But let's throw a variable into the equation and say that there is lingering redness. Obviously more length would be needed to camouflage the area. Color contrast has a bearing on this as well. The more narrow it is, the easier it is to hide. This is why one inch average length would adequately hide most strip scars but only by personal trial will you know for sure.

Best of wishes to you my friend and keep us in the loop!